Heart

The heart is a specialized muscle that pumps blood throughout the body. The blood carries oxygen and nutrients and distributes them to all parts of the body and removes waste products from various organs, most notably the lungs and kidneys. The heart is divided into two parts that work together. Deoxygenated blood flows from the organs and tissues into the right side of the heart, from where it continues to the lungs. The lungs remove carbon dioxide, which they replace with oxygen. Oxygen-rich blood flows into the left side of the heart, from where it continues to the body.

Chronic heart failure = epidemic of the 3rd millennium

Heart failure is a term for a range of symptoms caused by heart insufficiency. It often means the heart is unable to function properly as a pump. This means that the heart is unable to meet the body's demands.

Chronic heart failure occurs in 0.4-2% of the population in European countries, with a significant increase in older age groups. In the Czech Republic, this corresponds to approximately 200,000 patients, but it is necessary to add approximately another 200,000 who have impaired cardiac function but have not yet developed heart failure. Among other factors, the increasing number of patients with chronic heart failure is also due to improved treatment of acute myocardial infarction and other acute conditions.

Inadequately treated heart failure can have a serious prognosis. Diagnosis and treatment are demanding, not only medically but also economically. The consequence and manifestation of heart failure is the accumulation of blood and body fluids in the lungs, in the organs of the abdominal cavity, or in the lower limbs. In the case of blood accumulation in the lungs, the condition manifests itself in impaired breathing, or a dry, irritating cough. When body fluids accumulate in the organs of the abdominal cavity, it manifests itself, for example, in pain under the right rib cage (due to an enlarged liver) or in abdominal swelling, with feeling of fullness, loss of appetite and impaired absorption of medications. If excessive fluid accumulates in the lower extremities, the feet swell and the patient often cannot put on shoes. The development of edema is accompanied by an increase in body weight, often by several kilograms within a few days or weeks.

The body tries to prevent heart failure through several mechanisms:

• by reducing effort
• by enlargement of mainly the left ventricle
• by accelerating the heart rate

Heart failure

Heart failure can occur suddenly or develop gradually.

We are talking about

1. acute heart failure (sudden onset)
2. chronic heart failure (gradually developing)

Heart failure can also be divided into:

RIGHT-SIDED heart failure with typical symptoms:

• fluid accumulation in the body
• weight gain
• dilation of the neck veins
• enlargement of the abdominal organs (pain under the right rib cage due to liver enlargement)
• impaired digestion due to congestion of the stomach and intestines
• swelling of the lower extremities, mainly in the ankles and calves, sometimes above the knees, exceptionally to the waist or back

LEFT-SIDED heart failure with typical symptoms:

• impaired breathing during exertion, later also at rest, nighttime shortness of breath, sometimes the failure can be so severe that shortness of breath occurs even with minimal exertion (e.g. talking) or even at rest
• dry irritating cough
• accelerated heart rate, palpitations or skipping heartbeat
• fatigue, inefficiency

Both conditions can occur simultaneously to varying degrees.

Typical causes of heart failure:

• heart attack or post-heart attack condition with impaired left ventricular function
• aortic stenosis – narrowing of the heart valve preventing the expulsion of blood
• high blood pressure
• dilated cardiomyopathy – enlargement of the heart chambers due to severe damage to the heart muscle
• Mitral stenosis – narrowing of the valve separating the left atrium from the left ventricle of the heart leading to reduced blood flow from the left atrium to the left ventricle
• aortic regurgitation – backflow of blood from the aorta into the left ventricle caused by aortic valve dysfunction
• acute myocarditis – inflammation of the heart muscle caused, for example, by a viral infection
• heart rhythm disorders

PREVENTION

• primary – prevention and consistent treatment of all diseases that can lead to heart damage (for example, treatment of high blood pressure, prevention of ischemic heart disease)
• secondary – preventing the worsening of an already existing disorder

EXAMINATION

• Tests routinely performed to diagnose heart failure include ECG, echocardiography, chest X-ray, magnetic resonance imaging, cardiac catheterization, spirometry, and others.

THERAPY

The goal is:

• improve quality of life – reduce or completely eliminate symptoms, increase exercise tolerance, reduce mortality, and thus prolong the life of patients

Pharmacological treatment

• ACE inhibitors, sartans, ARNI
• Beta-blockers
• Diuretics
• Mineralocorticoid antagonists
• Digoxin
• Ivabradine
• Vasodilators
• Anticoagulants
• Antiaggregant
• Amiodarone

All of these medications are often used by patients with heart failure. They help improve heart function, regulate heart rhythm, help remove excess water from the body, and help regulate blood pressure.

It is very important to use the maximum doses of individual medications as recommended and as tolerated by the patient. For this reason, medications may need to be adjusted more frequently to determine the most appropriate combination and dosage. It is not recommended to change medications without consulting your doctor.

Surgical and instrumental treatment

• Surgical or catheterization – revascularization for ischemic heart disease, often by so-called percutaneous coronary intervention (PCI), i.e. by “expanding” the narrowed arteries with a balloon and inserting a coronary stent, or by surgically stitching aortocoronary bypasses
• Pacemakers, implantable cardioverter-defibrillators (for heart rhythm disorders, as part of the prevention of sudden death)
• Mechanical heart support systems (cardiac dysfunction in critical heart conditions)
• Cleansing methods (support and replacement of kidney function)
• Heart transplant

Regime measures:

• Weight loss in overweight and obese patients
• Reducing the intake of large amounts of fluids (1.5 – 2 l/day is recommended, be careful not to drink large amounts of fluids at once (beer))
• Limiting salt intake to < 4–5 g/day (beware of hidden salt in canned and instant foods)
• Alcohol withdrawal
• Smoking cessation
• Adequate physical exercise – regular fitness training, e.g. walking, light cycling, swimming. During these activities, it is possible to use pedometers, measure heart rate and blood pressure and record the daily number of steps or total physical activity.

The regime measures also include the so-called self-monitoring, i.e. monitoring your health status:

• Regular measurement of blood pressure and pulse
• Regular monitoring of body weight (preferably at the same time every morning)
• Abdominal circumference measurement
• Monitoring of lower limb swelling.

It is advisable to bring such a record with you to every check-up with your doctor.

Dietary measures

• The basis is a rational, balanced diet with enough of all nutrients and with the aim of maintaining optimal weight.
• The diet should be given in smaller portions five to six times a day, should contain enough fiber and fruit, and should not be flatulent or irritating. It is necessary to take into account associated diseases or chronic medication used (diabetes mellitus, anticoagulants)
• Black coffee in the amount of 1-2 cups per day can be drunk, but not at night
• If you are overweight, a weight loss diet is necessary.

Travel:

• Traveling to excessively hot regions and areas with high humidity is not recommended, avoid prolonged exposure to the sun.
• Long flights or long bus journeys are not recommended.
• Always consult your doctor before your planned trip, take a medical report with a short summary in English with you
• Don't forget to take enough medication with you.
• It is recommended to take out appropriate travel insurance.